BACKGROUND The standard medical regimen for SSNHL is systemic steroid therapy. Unfortunately, some patients either do not or poorly respond to systemic steroids. Intratympanic administration of steroids has been suggested as an alternative to systemic therapy. OBJECTIVE To determine if intratympanic dexamethasone injection (ITDI) is an effective treatment for sudden sensorineural hearing loss (SSNHL) in patients that systemic steroid treatment has failed. METHODS A prospective, non-randomized, controlled study evaluated the hearing outcomes in 14 SSNHL patients treated with ITDI as compared with the outcome of seven patients not treated. Intratympanic dexamethasone was administered through a spinal needle under local anesthesia. ITDI was performed once every week for maximum of three sessions. Hearing was assessed immediately before the therapy and 4 weeks after the therapy. RESULTS Hearing improvement was documented in six of 14 patients (43%) who underwent ITDI compare to none of the seven patients (0%) in no ITDI group. However, this was not statistically significant (p = 0.055). CONCLUSIONS Intratympanic dexamethasone (ITDI) may have benefits for patients with SSNHL who failed systemic steroid therapy.